On Monday the New York Times published an article titled, “Contraceptive Used in Africa May Double Risk of H.I.V,” which suggests that injectable contraception use may increase the risk of HIV transmission. The article, which sites a recent study published by The Lancet Infectious Diseases, is causing worldwide concern about the safety of hormonal contraception, but what do the study findings really mean? And what are the implications for the field?
Globally 5 million young people are living with HIV, and approximately 3,500 young people are infected with HIV every day. Young women are especially vulnerable to HIV; females make up 57% of all young people living with HIV. Injectable contraception is particularly popular among young women aged 16-25 years, the same population that is at highest risk for contracting HIV. Many young people prefer injectables because they are private and do not require a daily regimen. Contraceptives, including injectable contraception, play a very important role in reducing unintended pregnancies, abortions and associated negative maternal health outcomes. The risks associated with early and unintended pregnancy are severe for adolescent girls. Each year, approximately 16 million girls between the ages of 15-19 give birth and pregnancy is the number one cause of death among females age 15-19.
Given this new information, how can we, as public health professionals ensure that young women are both protected from HIV, and are also provided with the most appropriate contraceptive options?
The World Health Organization (WHO) has indicated that it will make no immediate change in contraceptive guidelines. Scientists acknowledge that while the study cited in the New York Times article does have strengths, the findings were derived from observational data and thus may not be conclusive. Given the life saving benefits of contraceptives, these services must remain accessible to youth. It is important to ensure that all providers evaluate any possible HIV risk associated with injectable contraception in the context of the proven benefits of effective contraception. More emphasis must be placed on dual protection. In general, women at risk for HIV are never encouraged to use a hormonal method alone without using a condom for disease prevention. These findings emphasize the importance of counseling young people about the consistent use of condoms with all hormonal and non- hormonal contraceptives for the prevention of HIV and STIs.